Hello, welcome everybody, this is doctor Bolad, board certified physician in cardiology, interventional
cardiology and internal medicine. I am here to help you with all the information you need
for your heart health and to inform you about all the latest treatments in cardiology. If
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Today, I will be talking to you about Heart catheterization, also called Cardiac catheterization also known as “cardiac cath,"
for short is a procedure that we perform to evaluate certain heart problems to understand
how the patient’s heart is working. Common reasons for performing this procedure is to
diagnose possible cardiac causes of chest pain, to evaluate the coronary arteries after
having an abnormal heart stress test, to evaluate abnormal heart valve conditions such as a
narrowed or leaky heart valves, to evaluate high blood pressure in the arteries of the
lungs, or to evaluate an enlarged or weak heart. The procedure takes about an hour or
so, and you are awake during the procedure but you are given medicines to make you relaxed
and take any pain away. This is an invasive procedure that is done
in the cardiac catheterization laboratory or the operating room. There are two types
of heart catheterizations. Left heart catheterization evaluates issues in the left side of the heart
and heart catheters are passed through the aorta to the left side of the heart. The other
type is right heart catheterization and this is done to evaluate issues in the right side
of the heart, and catheters are passed through the veins to the right side of the heart.
In this presentation, I will be talking about left heart catheterization.
There are two components of the left heart catheterization. When the catheters are passed
to the heart to evaluate blockages in the coronary arteries that are on the surface
of the heart, the procedure is known as CORONARY ANGIOGRAPHY. When catheters are passed to
the chambers of the left side of the heart, either to measure pressure, or to evaluate
the heart function or perform invasive work in the chamber of the heart, the procedure
is labelled as CARDIAC CATHETERIZATION.
Here is how I perform the procedure. The patient is brought to the cardiac catheterization
laboratory and either the wrist or the groin is cleaned and prepared for access to the
arterial circulation. The choice of the access site whether through the wrist or the groin
depends on multiple factors such as operator preference and experience, medical issues
such as blood thinning or anatomical issues or medical issues that the patient might be
experiencing. Here is an example of how I access the radial artery by a small needle
followed by insertion of a short sheath. If I chose the groin to access the arterial circulation
through the femoral artery, I usually take a check shot, and this is how it looks on
the X-ray monitor. After I gain arterial access, I insert a short
sheath either in the wrist or the groin. A long wire is passed through the artery and
then into the ascending aorta. Using a long wire, I load longer tubes, called CATHETERS,
and pass them all the way to the ascending aorta, very close to the origin of the coronary
arteries. Here is how I load the wire into the catheter ……………… and here is
how it looks like on the X-ray machine bringing the tip of the catheter close to the origin
of the coronary arteries. I then remove the long wire and remove air from the catheter,
and then I direct the tip of the catheter under X-ray imaging to the origin of the coronary
arteries. Commonly, I engage first the left main stem artery by pointing the tip of the
catheter to the left side. This artery acts like a tree trunk, and two main arteries that
feed the left side of the heart, branch from it. One artery is called the left anterior
descending artery, abbreviated as LAD, and this is the main artery that delivers oxygenated
blood to the main muscle of the heart, the LEFT VENTRICLE. This artery runs on the front
of the heart and has branches such as the diagonal arteries and septal arteries and
extends to the apex of the heart. This is how it looks like on the X-ray monitor during
the procedure………….. The second artery that originates from the
left main stem is known and the CIRCUMFLEX ARTERY and is generally abbreviated as Cx.
This artery turns left immediately after its origin and continues to course on the left
side of the heart and then to the back of the heart, giving branches known as obtuse
marginal arteries on its way. This is how it looks like on the X-ray monitor during
the procedure ………… After completing visualization of the arteries
on the left side of the heart, I remove the catheter and replace it by another catheter
with a differently shaped tip, shaped to engage the origin of the right coronary artery. Contrast
is injected to visualize that artery as it courses on the right side and then the back
of the heart giving branches such as the acute marginal artery, the posterior descending
artery and the posterolateral artery. This is how it looks like on the X-ray monitor
during the procedure …………. After that, I remove the right coronary artery
catheter and replace it by another catheter with a curled tip and that catheter is medically
known as the PIGTAIL catheter. This catheter is designed to cross the AORTIC VALVE into
the left ventricle, the main pumping chamber of the heart that pushes blood out of the
heart into the circulation. When the catheter is in place, I inject contrast into the left
ventricle to evaluate the contraction of the heart to assess whether the function is reduced
or not. This is how it looks on the X-ray monitor during the procedure ………….
Subsequently I remove the pigtail catheter from the heart and the access sheath in the
wrist or the groin is removed and pressure applied for a short while to control bleeding.
To recap what you have just seen me doing in the catheterization laboratory, I am going
to demonstrate it on this heart model. -------
After the procedure, I discuss the findings with the patient and family, and I also discuss
the treatment options if the finding warrants that.
If you have any questions about what I presented to you today, or any cardiology question in
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health, thanks for watching, and talk to you soon.